February 19, 2016BMC Cardiovascular DisordersOpen Access

Inotropic agents use in patients hospitalized with acute decompensated heart failure: a retrospective analysis from a 22-year registry in a Middle-Eastern Country (1991–2013)

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Why the study?

Does intravenous inotropic support impact in-hospital mortality and complications in patients hospitalized with acute decompensated heart failure?

Structured PICO

Does intravenous inotropic support impact in-hospital mortality and complications in patients hospitalized with acute decompensated heart failure?

Population

8,066 patients hospitalized with acute decompensated heart failure (ADHF) at Hamad Medical Corporation, Qatar between 1991 and 2013.

Intervention

Intravenous inotropic support (dopamine ≥5 μg/kg/min, or any dose of epinephrine, norepinephrine, dobutamine, or milrinone)

Comparator

No inotropic support

Outcome

Predictors of inotropic agent use and in-hospital outcomes including mortality, length of stay, and complicationshard clinical

Inotropic agent use in acute decompensated heart failure is associated with increased in-hospital mortality and complications, highlighting the need to restrict their use to appropriate indications like cardiogenic shock.

Limitations

Historical and observational design
Missing data or measurement errors
Non-randomized design leading to baseline differences
Unmeasured confounding factors

Implication

Inotrope-associated higher mortality in ADHF warrants caution outside shock; leaves open causality and indications for randomized trials.

Abstract

BACKGROUND: Data about the use of positive inotropic agents in patients hospitalized with acute decompensated heart failure (ADHF) is limited. METHODS: The records of 8066 patients with ADHF who were hospitalized at Hamad Medical Corporation, Qatar from 1991 to 2013 were analyzed to explore demographics and clinical characteristics of the patients according to inotropic agents use. RESULTS: Eight hundred fifty eight patients [10.6%, 95% CI (10 to 11.3%)] received intravenous inotropic support. Patients receiving inotropes were more likely to be female and have preserved ejection fraction when compared to those not receiving inotropic agents. Comorbidities associated with higher likelihood of receiving inotropic treatment included acute myocardial infarction, chronic renal impairment, dyslipidemia, hypertension, obesity and hyperglycemia. Patient on inotropes were more likely to undergone percutaneous coronary intervention (PCI), intra-aortic balloon pump support and intubation. There were no differences in the mean plasma BNP and CK-MB levels between the 2 groups. Heart failure patients receiving inotropes also were more likely to have complications including ventricular tachycardia (2.0% vs. 0.9%, p = 0.003), prolonged hospital stay (8.0 vs. 5.0 days, p = 0.001), cardiac arrest (14.6% vs. 3.2%, p = 0.001) and in-hospital mortality (30.8% vs. 9.1 %, p = 0.001). Over the study period there was an increase use of inotropic agents and decreased mortality rates. CONCLUSION: Inotropic use increased over the period whereas; female gender and conventional cardiac risk factors were predictors of inotropic agents use in the study.